Provider Demographics
NPI:1447805130
Name:AVERY, MELISSA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:AVERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 W CHITWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-2642
Mailing Address - Country:US
Mailing Address - Phone:602-460-2912
Mailing Address - Fax:
Practice Address - Street 1:903 AZ-260
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541
Practice Address - Country:US
Practice Address - Phone:928-468-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN14244163WE0003X
AZRN41244163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency